Amputations
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Introduction[edit|edit source]
Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. In some cases, it is carried out on individuals as a preventative surgery for such problems. A special case is that of congenital amputation, a congenital disorder, wherefetal limbs have been cut off by constrictive bands. In some countries, amputation of the hands, feet or other body parts is or was used as a form of punishment for people who committed crimes. Amputation has also been used as a tactic in war and acts of terrorism; it may also occur as a war injury.[1]
Causes of amputations[edit|edit source]
Congenital[edit|edit source]
- Congenical limb deficiency[2]
- Phocomelia: "a congenital deformity in which the limbs are extremely shortened so that the feet and hands arise close to the trunk"[3]
Acquired[edit|edit source]
- Vascular
- Ischaemia
- Diabetes
- 冻伤
- 动脉不足leading to death or decay of body tissue (gangrene)
- Chronic leg ulcer leading toSepticaemia
- Malignant tumours e.g. sarcoma (cancer of the connective tissue)
- Trauma (limb buried under / crushed by heavy object, limb damaged by car accident, stabbing, gunshot, animal bite etc.); in some cases leading to
- Traumatic amputation:a physical (non-surgical) separation of the limb in the course of the traumatic event
Levels of amputation[edit|edit source]
-
Upper Limb
- Forequarter
- Shoulder Disarticulation SD
- Transhumberal (Above Elbow AE)
- Elbos Disarticulation ED
- Transradial (Below Elbow BE)
- Hand/ Wrist Disarticulation
- Transcarpal (Partial Hand PH)
- Forequarter
- Lower Limb
- Hemipelvectomy
- Hip Disarticulation HP
- Transfemoral TF (Above Knee AK)
- Knee Disarticulation KD
- Transtibial TT (Below Knee BK)
- Ankle Disarticulation
- Symes
- Partial Foot PF (Chopart)
Surgical procedures[edit|edit source]
Surgical procedures
- myodesis: the muscles and fascia are sutered directly to the distal residual bone for better prosthetic control
- myoplastic: suture to opposite muscle in the residual limb to to each other and to the periosteum or to the distal end of the cut bone for weight bearing purposes
Ideal stump[edit|edit source]
- skin flaps: skin should be mobile, sensation intact, no scars
- muscles are divided 3 to 5 cm distal to the level of bone resection
- 神经是轻轻地拉剪干净,所以they retract well proximal to the bone level to reduce the complication of neuroma
Location of pulses[edit|edit source]
- Foot pulse (Medial malleolusor dorsum of the foot)
- Popliteal (behind the knee)
- Femoral (within the femoral triangle)
- If a leg has been amputated because of gangrene, the remaining leg is examined for a pulse
Special investigations[edit|edit source]
- X-rays
- CT scan
- Angiogram (outlines blood vessels)
- Doppler ultrasound (occlusion of vessels)
- Venogram and arteriogram
- Radioactive dye injected into the blood
Arterial insufficiency[edit|edit source]
- Surgery to improve circulation
- Bypass grafts (autogenous graft uses a vein to bypass the obstructed area)
- Synthetic grafts
Management[edit|edit source]
Buerger’s exercises[edit|edit source]
[4] |
- Stimulates collateral blood flow in the patient’s leg
- It is performed for 20 min.
- The leg is elevated until the toes go white, then lowered, then level
- Repeat 2-3 times to improve collateral circulation
Connective tissue massage[edit|edit source]
Dynamic stump exercises[edit|edit source]
Balance and gait retraining[edit|edit source]
- Improvestaticanddynamicbalance
- UseParallel bars,walking framethenCrutches(in that order)
- Therapist stands on the amp side, using a belt around the patient’s waist to support
- Rest if the patient feels tired
[5] | [6] |
[7] | [8] |
Short wave diathermy (SWD)[edit|edit source]
Through the pelvis to warm the arteries (contraindicated in patients with arterial insufficiency because the warmth leads to increased metabolism, causing a greater demand for nutrients, which are not available)
Post-operative care[edit|edit source]
- Maintain function in the remaining leg and stump to maintain peripheral circulation
- Maintain respiratory function (important with smokers and those patients under general anaesthesia)
Stump care[edit|edit source]
[9] |
- For hygiene and skin care see handout on amputations
- A hip flexionContracturemay develop because of elevation to reduce swelling
- Stump bandaging is done to ‘cone’ the stump, thereby preventing oedema, which occurs because there is no muscle pump and the stump hangs
- Swelling must be prevented to allow proper attachment of theProsthesis, and the prevention ofPressure sores
- The stump sock is put on first, then the prosthesis
- The prosthesis must be cleaned and maintained (Children who are still growing, grow out of their prostheses)
Mobility Aids[edit|edit source]
- The choice of mobility aids depends on the level of fitness, strength, balance skills of the individual:
- 行走架
- Axillary crutches
- Elbow crutches
- Walking stick
- For bilateral lower limb amputees a wheelchair is indicated (high energy expenditure during gait with prostheses)
Complications[edit|edit source]
- Phantom limb pain
Recent Related Research (fromPubmed)[edit|edit source]
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References[edit|edit source]
- ↑Wikipedia. Amputation.http://en.wikipedia.org/w/index.php?title=Amputation(accessed 29 May 2014).
- ↑Day HJB. The ISO/ISPO classification of congenital limb deficiency. Prosthetics and Orthotics International 1991; 15: 67-69.
- ↑MedlinePlus. Medical Dictionary, phocomelia.http://www.merriam-webster.com/medlineplus/phocomelia(accessed 29 May 2014).
- ↑ladybessviernes, UDM PT Students. Buerger Allen's Exercise. Available from:http://www.youtube.com/watch?v=jQUFmOmX35o[last accessed 01/12/12]
- ↑Clegstories. Gait Training with C-Leg®: Stance Phase Training. Available from:http://www.youtube.com/watch?v=Xh4rPJFgRx8[last accessed 08/12/12]
- ↑Clegstories. Gait Training with C-Leg®: Swing Phase Training. Available from:http://www.youtube.com/watch?v=E11gQs0oIt0[last accessed 08/12/12]
- ↑Clegstories. Clegstories. Gait Training with C-Leg®: Sitting Down and Standing Up. Available from:http://www.youtube.com/watch?v=_lBkrLZ4PGo[last accessed 08/12/12]
- ↑Clegstories. Gait Training with C-Leg®: Stairs. Available from:http://www.youtube.com/watch?v=Z6bvgDaOkcI[last accessed 08/12/12]
- ↑Richard Major. Physiotherapy Stump or Residual Limb Wrapping. Available from:http://www.youtube.com/watch?v=T1SA_6hzTxQ[last accessed 08/12/12]